Dilation and Curettage

Description

Dilation and curettage (D&C) is the dilation of the uterine cervix with the removal (by scraping) of a portion of the uterine lining or uterine contents. (The same term may be applied to any setting in which a cavity is curetted after gaining entrance through dilation, such as endocervical curettage of a cervical stump.) The procedure may be combined with other diagnostic procedures such as hysteroscopy.

Indications

D&C may be performed for either diagnostic or therapeutic indications. This can range from the control of acute bleeding or an incomplete abortion to the temporary treatment of dysfunctional bleeding. Office endometrial biopsy, hysteroscopy, and sonohysterography have replaced D&C as a diagnostic modality in many cases.

Contraindications

Patients who are medically unstable, viable or desired pregnancy, active pelvic inflammatory disease, blood dyscrasia.

Required Equipment

• Sterile gloves

• Skin preparation materials (generally an iodine-based antibacterial solution such as povidone-iodine [Betadine])

• Vaginal speculum or weighted vaginal speculum with Deaver or similar retractors

• Single tooth tenaculum

• Graduated cervical dilators (Hegar, Pratt, Rocket, Heaney, Hank, or similar; Goodell dilators are generally not preferred because of an increased risk for cervical laceration)

• Blunt uterine sound (optional)

• Uterine curettes (sharp preferred) in a selection of sizes

• Small stone forceps (Randall or similar)

• Polyethylene terephthalate-covered dressing (Telfa or similar; optional)

• Suitable tissue preservation/transportation medium (10% formalin solution or similar)